RISKS FOR MAJOR BLEEDING FROM THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE PULMONARY-EMBOLISM - CONSIDERATION OF NONINVASIVE MANAGEMENT

被引:69
作者
STEIN, PD [1 ]
HULL, RD [1 ]
RASKOB, G [1 ]
机构
[1] HENRY FORD HEART & VASC INST, DETROIT, MI USA
关键词
PULMONARY EMBOLISM; HEMORRHAGE; THROMBOLYTIC THERAPY; ANGIOGRAPHY; ALTEPLASE;
D O I
10.7326/0003-4819-121-5-199409010-00001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To assess the relative risks for bleeding with thrombolytic therapy in patients who are managed using pulmonary angiograms compared with those managed using noninvasive tests, primarily the ventilation-perfusion lung scan. Design: A decision analysis based on data from other studies. Methods: The risk for major bleeding in patients with pulmonary embolism who receive thrombolytic therapy after a noninvasive diagnosis was assessed from complications of thrombolytic therapy in patients with myocardial infarction, assuming that the same risk ratio for major bleeding when comparing an invasive with a noninvasive approach applied to patients with pulmonary embolism. The risk ratio was 3.3 (95% CI, 1.5 to 9.8) for major bleeding in patients with myocardial infarction. One or more major complications of pulmonary angiography occurred in 1.3% of patients (CI, 0.6% to 1.9%). Results: The average reported risk was 14% (18 of 129 patients) (CI, 7.9% to 20.1%) for major bleeding in patients who had pulmonary angiography before receiving tissue plasminogen activator (tPA). The estimated risk was 4.2% (estimated CI, 1.4% to 9.3%) for major bleeding with tPA after a noninvasive diagnosis of pulmonary embolism. Assuming a risk of 1.3% for major complications from pulmonary angiography, a risk for major hemorrhage of 14.0% for an invasive diagnosis, and a risk of 4.2% for a noninvasive diagnosis, fewer complications would occur with noninvasive management if the prevalence of pulmonary embolism exceeded 21%. Conclusion: Among patients with suspected pulmonary embolism who are candidates for thrombolytic therapy, it is safer to use noninvasive diagnostic tests in many patients.
引用
收藏
页码:313 / 317
页数:5
相关论文
共 28 条
[1]  
[Anonymous], 1990, LANCET, V336, P65
[2]  
[Anonymous], 1990, CHEST, V97, P528
[3]   HEMORRHAGIC COMPLICATIONS ASSOCIATED WITH THE USE OF INTRAVENOUS TISSUE PLASMINOGEN-ACTIVATOR IN TREATMENT OF ACUTE MYOCARDIAL-INFARCTION [J].
CALIFF, RM ;
TOPOL, EJ ;
GEORGE, BS ;
BOSWICK, JM ;
ABBOTTSMITH, C ;
SIGMON, KN ;
CANDELA, R ;
MASEK, R ;
KEREIAKES, D ;
ONEILL, WW ;
STACK, RS ;
STUMP, D .
AMERICAN JOURNAL OF MEDICINE, 1988, 85 (03) :353-359
[4]   PAIMS-2 - ALTEPLASE COMBINED WITH HEPARIN VERSUS HEPARIN IN THE TREATMENT OF ACUTE PULMONARY-EMBOLISM - PLASMINOGEN-ACTIVATOR ITALIAN MULTICENTER STUDY-2 [J].
DALLAVOLTA, S ;
PALLA, A ;
SANTOLICANDRO, A ;
GIUNTINI, C ;
PENGO, V ;
VISIOLI, O ;
ZONZIN, P ;
ZANUTTINI, D ;
BARBARESI, F ;
AGNELLI, G ;
MORPURGO, M ;
MARINI, MG ;
VISANI, L .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 20 (03) :520-526
[5]   ADJUSTED SUBCUTANEOUS HEPARIN OR CONTINUOUS INTRAVENOUS HEPARIN IN PATIENTS WITH ACUTE DEEP-VEIN THROMBOSIS - A RANDOMIZED TRIAL [J].
DOYLE, DJ ;
TURPIE, AGG ;
HIRSH, J ;
BEST, C ;
KINCH, D ;
LEVINE, MN ;
GENT, M .
ANNALS OF INTERNAL MEDICINE, 1987, 107 (04) :441-445
[6]   RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR VERSUS A NOVEL DOSING REGIMEN OF UROKINASE IN ACUTE PULMONARY-EMBOLISM - A RANDOMIZED CONTROLLED MULTICENTER TRIAL [J].
GOLDHABER, SZ ;
KESSLER, CM ;
HEIT, JA ;
ELLIOTT, CG ;
FRIEDENBERG, WR ;
HEISELMAN, DE ;
WILSON, DB ;
PARKER, JA ;
BENNETT, D ;
FELDSTEIN, ML ;
SELWYN, AP ;
KIM, DS ;
SHARMA, GVRK ;
NAGEL, JS ;
MEYEROVITZ, MF .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 20 (01) :24-30
[7]   ALTEPLASE VERSUS HEPARIN IN ACUTE PULMONARY-EMBOLISM - RANDOMIZED TRIAL ASSESSING RIGHT-VENTRICULAR FUNCTION AND PULMONARY PERFUSION [J].
GOLDHABER, SZ ;
HAIRE, WD ;
FELDSTEIN, ML ;
MILLER, M ;
TOLTZIS, R ;
SMITH, JL ;
DASILVA, AMT ;
COME, PC ;
LEE, RT ;
PARKER, JA ;
MOGTADER, A ;
MCDONOUGH, TJ ;
BRAUNWALD, E .
LANCET, 1993, 341 (8844) :507-511
[8]  
GOLDHABER SZ, 1988, LANCET, V2, P293
[9]   DIFFERENT INTENSITIES OF ORAL ANTICOAGULANT-THERAPY IN THE TREATMENT OF PROXIMAL-VEIN THROMBOSIS [J].
HULL, R ;
HIRSH, J ;
JAY, R ;
CARTER, C ;
ENGLAND, C ;
GENT, M ;
TURPIE, AGG ;
MCLOUGHLIN, D ;
DODD, P ;
THOMAS, M ;
RASKOB, G ;
OCKELFORD, P .
NEW ENGLAND JOURNAL OF MEDICINE, 1982, 307 (27) :1676-1681
[10]   HEPARIN FOR 5 DAYS AS COMPARED WITH 10 DAYS IN THE INITIAL TREATMENT OF PROXIMAL VENOUS THROMBOSIS [J].
HULL, RD ;
RASKOB, GE ;
ROSENBLOOM, D ;
PANJU, AA ;
BRILLEDWARDS, P ;
GINSBERG, JS ;
HIRSH, J ;
MARTIN, GJ ;
GREEN, D .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 322 (18) :1260-1264